Baldness (Alopecia)

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Lichen Planopilaris

Overview

Lichen planopilaris is a type of lichen planus, a common skin disease that affects hairy areas of the body, causing inflammation, hair loss, and scarring. In some cases, lichen planopilaris leads to permanent hair loss.

Causes

Exposure to certain chemicals and allergic reactions to certain drugs are known to cause "lichenoid" reactions, though how is unclear. For example, exposure to antimalarial agents, penicillin, beta blockers, nonsteroidal anti-inflammatory drugs, and gold has been known to cause lichen planus. The reaction can occur within weeks or years of exposure to the drug or the offending agent. Some cases of lichen planus have been linked to hepatitis virus C (HVC) infection.

Signs and Symptoms

Papules are small, elevated areas on the skin (like pimples). In lichen planopilaris, the papules are purple, reddish purple, or white and shiny with flat tops and uneven shapes. They are often very itchy.

Treatment

Lichen planopilaris should be treated as quickly as possible to avoid permanent hair loss. Treatment is individualized because severity of symptoms, extent of the lesions (papules), and response to treatment vary. If a drug or chemical is the suspected cause, the drug should be discontinued and the chemical avoided. Treatment may include the following:

• Antihistamines to relieve moderate itching
• Injectable triamcinolone acetonide to treat large, itchy lesions
• Systemic corticosteroids (e.g., oral prednisone) for severe cases
• Topical triamcinolone acetonide cream or another, more potent corticosteroid cream to relieve intense itching

Lichen planopilaris usually resolves without treatment, but can recur years later.

Lupus Erythematosus

Overview

Alopecia is one of many symptoms of lupus, an autoimmune disease. Not all people with lupus develop alopecia, and the pattern and severity depend on whether the disease is systemic or discoid.

Lupus affects more women than men and is more common among African American women than Latina, Asian, Native American, and Caucasian women.

Systemic lupus erythematosus (SLE), an inflammatory connective tissue disorder, can affect the joints, kidneys, skin, heart, lungs, blood vessels, and brain. About 20% of patients with this disorder have diffuse, nonscarring alopecia.

Discoid lupus erythematosus (DLE) causes raised, red rashes that become thick and scaly on the face, scalp, and other parts of the body. The rash can last days or years. DLE can cause oval patches of scarring alopecia.

Treatment

Treatment should begin early to avoid permanent scarring and may involve the following:

• Antimalarial medications (e.g., hydroxychloroquine), in severe cases, for months or years
• Injections of corticosteroids for difficult-to-treat lesions
• Patients should avoid the sun and other forms of ultraviolet light and should use sunscreen
• Topical corticosteroid ointments or creams for smaller lesions (excessive use should be avoided) and plastic tape coated with flurandrenolide (a corticosteroid) can sometimes be helpful

Baldness (Alopecia), Lichen Planopilaris, Lupus Erythematosus reprinted with permission from dermatologychannel.net
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